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Full text of "Navy Department BUMED News Letter Vol. 5, No. 5, March 2, 1945"

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Editor. - Comdr. 

F. R. 

Bailey, (r 

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S. N. R. 

Vol. 5 Friday, March 2, 1945 No. 5 


Evacuation by Air 2 Salmonellae: Animal Source 20 

Sulfonamides and Altitude Tolerance . .4 Enteric -Pathogen Survey 20 

DDT "5 Training Films: Distribution.. 22 

Par adichlor obenzene 7 Drug-Resistant Staphylococci 23 

Metrazol-Pentothal Antagonism 7 Penicillin and Bacteriolysis 23 

Appendicitis: Conservative Therapy. 10 Professional Qualifications Card 24 

Arteriovenous Aneurysm 11 Filariasis: Training Manual 24 

Post-Traumatic Headache 14 Immune Serum Globulin 24 

Fractures: Suspension Traction 14 Quarantine Regulations 25 

Burns: Whole Blood and Electrolytes. 16 Annual Sanitary Reports 28 

Syphilis: False-Positive Reactions... 17 Snake Bites 28 

Form Letters : 

Medical Department at NTC, Great Lakes SecNav 29 

Alnav 3 - Handling of Beer and Ale., SecNav 29 

Hospital Ticket - Women, NAVMED 416 BuMed 29 

Alnav 5 - Identification of Bodies SecNav 31 

Disposition of Disabled Enlisted Personnel BuPers ....31 

Qualifications for Submarine Medical Officer.... BuPers ....31 

Salt Water in Washing Machines on Shipboard BuShips....33 

Information on Disciplinary Action of Transferred Patients Joint Ltr.... 34 

Alnav 33 - Extension of Dating Period - Human Serum Albumin SecNav 35 

Alnav 12 - Marriages, Nurse Corps SecNav 36 

Marriages, Nurse Corps BuMed 36 

Identification of BuMed Forms and Publications BuMed 37 

Roentgenograph^ Examinations BuMed 38 

HC Personnel Recommended for Training Courses BuMed 44 

Prerequisites of HC Personnel for Training Courses BuMed ......45 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Air Evacuation : Because of the great value of air transport in the evacu- 
ation of casualties and of the sick, the Bureau of Medicine and Surgery recom- 
mended the establishment of an air-evacuation service for patients in the 
Pacific area. This recommendation has been approved, and the service is 
now in process of accomplishment. 

This air-transport service will be subject to fleet cognizance and control. 
It is contemplated that the facilities of this service will be appropriately inte- 
grated into future operational plans in order that maximal use may be made 
of it in distributing sick and wounded personnel to hospitals in the forward 
area and moving them from these hospitals to base hospitals in the rear 
(Pearl Harbor and the Continental United States). 

In order to develop this service so that it may render the best possible 
medical care, a school for flight nurses has been established at Alameda, Cali- 
fornia. .Nurses and pharmacist's mates will be trained in preparation fpr as- 
signment to air -evacuation squadrons in the Pacific area. A flight surgeon of 
appropriate rank and experience with such other medical personnel as are re- 
quired also will be assigned to each air evacuation squadron. 

In order that this air -evacuation service may function properly in the 
Pacific area, it will be necessary, when long distances are involved, to pro- 
vide stagkig and medical facilities at intermediate islands for the accommoda- 
tion of the sick and wounded in transit. It will become the mission of the staff 
medical officer assigned to the air -evacuation command to make the appro- 
priate recommendations and to assist in the development of staging facilities. 
He should render such other instructional and liaison assistance as may be 
required to effectuate and coordinate a practical working service and to pro- 
vide information to hospitals and other medical activities which will make use 
of the air -evacuation service for their patients. 

The intelligent cooperation of medical officers in charge of medical acti- 
vities requiring the services of air transportation will be necessary if wise 
use is to be made of the service with a minimum of confusion. Air evacuation 
service for patients in the Pacific will be under the cognizance of Commander, 
Air Force, Pacific Fleet; Headquarters - Pearl Harbor, T. H. 

Within the continental limits of the United States arrangements have been 
made for the use of naval aircraft which will be provided by the Naval Air 
Transport Service for the transportation and redistribution of patients. NATS 
has allocated and equipped aircraft for this specific use. Regular planned 
flight schedules indicating time and place of departure and of arrival have been 
published for the information of all medical activities who may require air 
transportation for patients. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

BuPers Circular Letter No. 367-44 states that "in order to expedite the 
issuance of travel orders in connection with the transfer of patients , includ- 
ing the necessary attendants, when prior approval has been obtained from 

the Bureau of Medicine and Surgery orders may be issued by the 

medical officer in command of a naval hospital, and reimbursement for travel 
involved may be made by disbursing officers without further approval 
by BuPers." 

At the 'present time flight nurses under instruction will accompany planes 
where possible in regularly scheduled flights. In some. cases it will be neces- 
sary for local activities to supplement or provide medical attendants a s may 
be required. It is the hope of the Bureau that as this service develops and be- 
comes more thoroughly stabilized it will be possible to assign permanently 
flight nurses and pharmacist's mate attendants to all NATS aircraft employed 
for this purpose. All officers in command of naval hospitals and medical offi- 
cers of other activities are urged to employ these services whenever practicable. 

Further information pertaining to the availability of Naval Air Transport 
facilities for the transfer of the sick within the United States may be obtained ^ 
by communicating with the local district medical officer. (Aviation Med., 
BuMed - J. C. Adams) 

* * 

Evacuation of casualties by air is often expedient and at times a military 
necessity. Many excellent articles have been written with respect to the selec- 
tion of patients for evacuation by air, usually presenting lists of conditions that 
are adversely affected by the environmental conditions found at high altitude. 
In general, most patients who can be transported at all may be evacuated by air.' 

In selection of patients for transportation by air two basic physiological 
principles must be kept in mind: (1) When hypoxia exists or threatens because 
' of shock, exsanguination, respiratory or cardiac embarrassment or other condi- 
tion, subjecting the patient to a lowered partial pressure of oxygen may have 
serious consequences. (2) When the condition of the patient will deteriorate 
following the expansion of gas as is the case with injuries of the abdomen as- 
sociated with perforation of the bowel or injuries of the chest associated with 
pneumothorax, subjecting him to lowered barometric pressure may have a 
deleterious effect. Often steps can be taken to put a patient into better condi- 
tion for air transport, as by further resuscitation if he is in shock, or by as- 
piration of air from the chest if he has a pneumothorax. The limited facilities 
available in airplanes makes it unwise to transport by air patients who will re- 
quire extensive or continued medical or surgical treatment. 

- 3 - 

Burned News Letter, Vol, 5, No. 5 


Other factors also must be taken into consideration. Not infrequently, 
especially in short flights over water, one may have reasonable assurance 
that a. low altitude can be maintained; or the projected flight may be of short 
distance. Furthermore, with respect to those patients who may be harmed 
by further increase in anoxia, the availability of adequate equipment for the 
administration of oxygen may increase the safety of flights at fairly high 

Finally, it need hardly be mentioned that in selecting cases (triage) for 
air evacuation one must keep in mind the fact that only by air transport can 
certain patients reach medical activities where they can obtain special types 
of therapy which they urgently need. In military operations involving retro- 
grade movement the necessity for removing casualties by any means possible 
is apparent. 

Consequently, in the selection of individual patients for transport by air 
the flight surgeon and the medical officer must weigh the advantages t o b e 
gained against the hazards incident to the journey. For example, a patient 
with a condition ordinarily believed to contraindicate travel by air may, 
through proper medical preparation for flight and adequate medical care en 
route, be safely taken at low altitude for a short distance to a point where 
better facilities are available for his care. 

For further discussion of this important subject see Burned Aviation 
Supplement of 5 January 1945 and 2 February 1945. 


The Effect of Sulfonamides on Persons Subjected to Simulated Altitude: 
Peterson et al. studied three men decompressed in a chamber to a pressure 
level corresponding to 20,000 feet. "Ascents" were made before and after 
the administration of sulfathiazole in full therapeutic amounts. Blood levels 
of sulfathiazole varied between 11.4 and 16.0 mg. per 100 c.c. 

The oxygen saturation of the blood decreased with increasing simulated 
altitude, but showed no significant variation whether or not the subjects were 
receiving sulfathiazole. 

At a pressure corresponding to approximately 20,000 feet (350 mm. of 
mercury) administration of oxygen to the subjects resulted in a rapid restora- 
tion of the blood- oxygen content to normal whether or not sulfathiazole was given. 

The electrocardiogram showed no significant deviation during the sulfa- 
thiazole series which was not equally demonstrated in the control run. The 
changes which did occur consisted primarily of a progressive depression of 

Burned News Letter, Vol. 5, No. 5 


the T wave in lead I and a similar depression and inversion of the T wave in 
lead in. 

The pulse rate under the influence of sulfathiazole was not significantly 
different from that during the control run. In both instances, acceleration 
accompanied decompression. The pulse rate returned to predecompression 
values immediately after the administration of oxygen at simulated altitude. 

A significant amount of electroencephalographic abnormality did not ap- 
pear in either the control or the medicated series. Comparison failed to 
show any remarkable difference between them. 

It is worthy of note that all of the subjects experienced no untoward ef- 
fects from taking sulfathiazole, nor did they experience any significant dif- 
ference in the symptoms of anoxia when under medication. ' 

The authors conclude that sulfathiazole in full therapeutic doses does not 
significantly alter the ability of normal persons to withstand the effects of alti- 
tude and that the use of this drug is not contraindicated for wounded personnel 
who are to be transported at altitudes of less than 10,000 feet without oxygen 
or more than 10,000 feet when supplementary oxygen is provided. (War Med., 
Jan. '45) 

DDT: A recent survey conducted in several large units in the Pacific 
area indicates a need for further dissemination of information on the subject 
of DDT. This new insecticide is now available outside the continental limits 
of the United States in quantities sufficient for large-scale application. It is 
stocked at the Naval Supply Depot, Oakland, California, and at certain ad- 
vanced bases in the Pacific area. The fact that it is supplied only on requisi- 
tion necessitates considerable advance planning in order that shortages during 
critical periods may be avoided. ■ 

In order to obtain maximal effectiveness from DDT, it is necessary that 
certain modifications be made in equipment designedf or dispersing other insecti 
cides. The type of sprayer nozzle used is probably of greatest importance, 
the disc-whirler type being the best. A majority of the nozzles now available 
have too large an opening in the disc; the openings may be soldered over and 
redrilled to produce an opening equivalent to 60 wire gauge. The decontami- 
nation sprayer is generally best suited to the dispersal of DDT, although the 
nozzle with which it is equipped for employment in connection with chemical 
warfare must be altered for use with DDT. This sprayer is lighter than 
the knapsack sprayer, and the latter is less durable and more likely to spill 
DDT on the skin and clothing of the operator. A new hand sprayer of three- 
quart capacity is now available. When the larger nozzle is used, it lends itself 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

well to the application of residual sprays to solid surfaces as well as 
to "puddle" larviciding. The accessory nozzle, with a smaller opening, al- 
lows this sprayer to be employed for producing finer sprays for use against 
adult insects on the wing. 

Ordinary rubber hose and gaskets, with which many knapsack and decon- 
tamination sprayers are equipped, do not withstand the action o f petroleum 
oils. Synthetic rubber fittings should be obtained for sprayers so equipped. 
The filling of requisitions for these items of equipment usually requires con- 
siderable time; therefore planning in advance and periodic checking on requisi- 
tions are advisable. 

Three Insecticides in One: The employment of DDT against mosquito 
larvae, against adults and as a residual spray gives DDT three highly special- 
ized and separate usages. Satisfactory result's, however, depend upon the 
material's being used differently for these separate functions. As a residual 
spray, it must be applied in semi- coarse droplets, the nozzle being held from 
six to twelve inches from the surface being sprayed. Using five per cent DDT 
in emulsion, or in kerosene, the surface should be wet to a degree just below 
that at which drops are running off . The ideal amount is 100 to 200 mg. (2 to 4 
c.c. of 5% solution) per square foot. The surfaces which insects frequent 
should receive special attention. Fine sprays tend not to adhere to sur- 
faces in amounts adequate for prolonged effectiveness. If the material is prop- 
erly applied, insects coming into contact with the crystals adherent to the surface 
as long as 1 to 2 months after treatment will be killed. 

When DDT is employed as a larvicide, a semi-coarse spray should be used, 
as fine sprays will be blown away by the wind before they reach the surface of 
the water. Solutions of less than five per cent concentration are desirable, as 
it is difficult to spread evenly one quart of five per cent DDT solution over an 
acre of water surface. Two quarts of 2.5 per cent solution, however, may be 
evenly distributed over such an area. 

Finely atomized sprays are required for killing adults in the open. The 
fine droplets are carried b y the wind to the infested area. To produce fine 
sprays, nozzles with smaller openings and sprayers yielding higher pressures 
must be used, in contrast to those employed for residual spraying. When 
there is a light breeze and fine droplets are used, the operator should walk 
in 20-foot swaths. The effective swath -width is less with strong winds and 
when coarse droplets are used. 

The Toxicity of DDT to Humans is of a sufficiently low order to permit 
the use of DDT without danger to personnel if reasonable precautions are taken. 
(See Burned News Letter, Vol. 4, No. 11, pp. 4, and "Manual on DDT Insecticide' 
NavMed 292.) In spite of the extensive employment of this insecticide, to date 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

there has been no reported case of poisoning. This is, in large part, the result 
of observing previously published precautions and should not be interpreted 
as an indication that any relaxation in the observation of those precautions is 
warranted. (Prev. Med. Div., BuMed - F. T. Norris) 

!j: j|t ^ 3)c + 

Paradichlorobenzene in Fly Control : The importance of fly control i n 
preventing the spread of bacillary dysentery and other fly-borne diseases 
cannot be overemphasized. Paradichlorobenzene (C 5 H4 Cl 2} , sometimes 
called PDB , is a by-product of the chlorination of benzene that has proved to 
be a practical and efficient fly larvicide and insecticide. PDB is most effec- 
tive in latrine pits, garbage pits, uncovered graves, destroyed shelters or 
other places where the heavy gas generated will not be rapidly dissipated. 

No apparatus is required to apply the crystals to surfaces where flies 
are breeding. In handling PDB crystals no precautions against toxic effects 
are necessary. Larvicidal action is due to heavy fumes given off by the crys- 
tals. When PDB crystals are covered with earth the gas penetrates several 
inches in all directions. The larvicidal action progressively decreases as 
the temperature is lowered below 70° F. 

Five to eight pounds of PDB are adequate for initial application to an 
eight-hole latrine pit. To increase the effectiveness of PDB, latrines should 
be built reasonably tight, lids should be kept closed, and the contents of the 
latrine must not be of thin consistency. 

Although PDB has an established place in a general fly-control program, 
it should be used as an adjunct to other larvicides and insecticides and to other 
fly control measures such as other fly traps and screening, each of which has 
a definite use. 

PDB is listed in the Standard Stock Catalogue as 51D193 Dichlorobenzene, 
Para. It is available in 200-pound drums. (Prev. Med. Div., BuMed - J. F. 

Metrazol-Pentothal Antagonism : The use of metrazol as a means of in- 
creasing the safety of pentothal anesthesia has recently been suggested by 
Pickrell and Richards. 

These authors emphasize two disadvantages incident to this type of anes- 
thesia. The first is the apparent increase in depth of anesthesia or narcosis 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

which may occur at the termination of the operation when stimulation is no 
longer present, and which may be followed by a prolonged period of sleep. 
The second is the possible occurrence of a state of profound respiratory de- 
pression at any stage of the anesthesia, especially if large doses of pentothal 
have been used, and which in some instances may terminate in respiratory 
failure and death. 

Pentothal, in common with other barbiturates, exerts a depressant action 
on the central nervous system and produces an effect varying from slight 
sedation to deep coma. In large doses the barbiturates depress directly the 
medullary respiratory center, and both the depth and the rate of breathing 
are decreased and irregular. 

The antagonistic effect of metrazoi in barbiturate poisoning is well known. 
According to Pickrell and Richards metrazoi exerts a prompt and intense 
stimulating action on the vasomotor and respiratory centers in the medulla 
and on the cerebral cortex. The effect on the medullary centers is much 
more prominent when their functions are in a state of depression. When the 
circulation has been depressed by a hypnotic agent, metrazoi causes a marked 
rise in blood pressure. It is absorbed rapidly when administered intravenously, 
and its action is practically instantaneous. As it is readily soluble in water, it 
is absorbed rapidly when given by subcutaneous injection or by mouth. In large 
doses it possesses a strong convulsant action. It is rapidly detoxified, and its 
effects are not cumulative. 

The authors explored the possible value of metrazoi in the prevention o f 
prolonged pentothal narcosis and in the resuscitation of patients in profound 
respiratory depression. 

Seven cases are reported in which profound respiratory depression de- 
veloped during anesthesia with pentothal. In each case the intravenous adminis- 
tration of 5 c.c. of 10 per cent aqueous solution of metrazoi (3 c.c. in one case) 
was followed by prompt improvement. In each case the operation could be re- 
sumed with cautious administration of additional pentothal. In four instances a 
subsequent injection of 3 c.c. of metrazoi was made. No untoward reactions nor 
ill effects were noted, and no convulsions occurred. 

Following experiments using animals, in which it was found that the ad- 
ministration of metrazoi would arouse rabbits, but not dogs, from deep pento- 
thal anesthesia, the effect of metrazoi in shortening the recovery period after 
pentothal anesthesia in man was investigated. 

In control studies in which no metrazoi was given, the time required for 
recovery from pentothal anesthesia varied from 1-1/2 to 12 hours, depending 
upon the weight of the individual, the dose of anesthetic given and the magnitude 

Burned News Letter, Vol. 5, No. 5 


of the operation. The pentothal was administered in 2.5 per cent solution in 
combination with a mixture of 5 per cent dextrose in 0.85 per cent saline. 
The technic of intermittent administration was employed. Continuous adminis- 
tration of oxygen in high concentration was maintained during the entire period 
of anesthesia. 

In a series of 300 patients given pentothal in the same amounts and man- 
ner as the control group, 5 to 8 c.c. of metrazol were administered intraven- 
ously at the conclusion of the operation. The recovery period, except in 
16 instances, was not longer than 45 minutes. Frequently recovery of con- 
sciousness took place almost immediately. In the 16 patients mentioned, all 
of whom had received the maximal dose of 2 Gm. of pentothal, recovery was 
delayed for not more than 1-1/2 hours. (Abstracted from ms. of paper to be 

* * 

The work of Pickrell and Richards presented in abstract in the above 
item was called to the attention of the Bureau by Dr. Frank Lahey. The fol- 
lowing comment on its practical application was written for the Burned News 
Letter by Doctors Eversole, Hand and Nicholson of the Department of Anes- 
thesia of the Lahey Clinic: 

The experimental work of Pickrell and Richards and other investigators 
has demonstrated the efficacy of the convulsant analeptics (notably metrazol) 
in the treatment of barbiturate overdosage. Our clinical observations have 
borne out the observations of Pickrell and Richards that this drug is effec- 
tive as an antidote for pentothal overdosage. 

The two other drugs most commonly used for barbiturate overdosage are 
coramine and picrotoxin. The value of coramine is very doubtful; in f act , 
some observers believe that it at times increases depression. Picrotoxin is 
a more powerful convulsant (all of these drugs are convulsants and hence are 
potentially dangerous) and does have a more prolonged action than does metra- 
zol. It is probably not as safe a drug as metrazol. The routine use of the s e 
analeptic drugs with pentothal anesthesia is not to be recommended. They are 
all cerebral irritants and as such may cause convulsions. 

The first and most important step in the treatment of pentothal overdosage 
(as well as overdosage of any type of drug which causes respiratory depression) 
is artificial respiration. The artificial respiration should be carried out with 
oxygen if it is available. Artificial respiration, of course, presupposes the es- 
tablishment of an adequate and patent airway. This means tracheal intubation 
if necessary. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Secondly, metrazol should be employed as an adjuvant to artificial res- 
piration. The time consumed in the preparation and administration of this 
drug must not prolong the interval before artificial respiration is instituted. 

A third step in the management of these patients, of course, is the main- 
tenance of circulation by means of adequate fluid therapy and vasopressor 
drugs as indicated. 

We cannot stress too much the importance of a free airway and adequate 
respiratory exchange. Artificial respiration is the only resuscitative measure 
of proved effectiveness. 

* * . 

While metrazol is not on the Medical Supply Table, it can be obtained com- 
mercially. It is suggested that this drug be used as an adjunct to artificial res- 
piration and other resuscitative procedures of recognized value when respira- 
tory failure occurs during pentothal anesthesia. Until further confirmatory 
studies demonstrate that the use of metrazol routinely to shorten the recovery 
period following pentothal anesthesia Is entirely safe, its employment for this 
purpose is not recommended. 

* Conservative Treatment of Acute Appendicitis : In naval medicine situa- 
tions may be encountered, particularly by corpsmen on independent duty, in 
which a competent surgeon is not available or adequate facilities, and in 
which operative intervention in acute appendicitis may be hazardous. (See 
Burned News Letter, Jan. 21, '44.) It has been recommended that in such situa- 
tions conservative treatment be supplemented by the use of sulfonamide o r 

Lt. (jg) C. M. Riley (MO, USNR, has recently reported a case which is 
of considerable Interest because the patient was operated on approximately 
three days after conservative therapy was started. 

"An 18-year old seaman reported at sick call having had vague abdominal 
pain for about twenty-four hours and anorexia, but no frank nausea or vomiting. 
On examination he was found to have slight right-rectus rigidity and tenderness 
directly over McBurney's point, as well as rebound tenderness referred to this 
area. There was moderate generalized tenderness high in the rectum. Tempera- 
ture was 100.4° and white count was 14,700. A diagnosis of acute appendicitis 
was made. Because of the unsatisfactory conditions for operating aboard an 
old destroyer, medical treatment was selected. He was given sulfadiazine, 4 Gm. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

immediately, followed in four hours by 2 Gm., with 1 Gm. every four hours 
thereafter. The large initial doses were given in an effort to produce a high 
blood level rapidly. Six hours after the first dose physical findings were un- 
changed but the temperature had fallen to 99.6° and the white count to 12,000. 
After twelve hours there had been no appreciable change in signs or symptoms, 
but the temperature had fallen to 97.8° and the white count was 11,000. The 
next day the temperature remained normal and he began to have a little appe- 
tite. Significant physical findings at this time were limited to a diffuse abdomi- 
nal tenderness. On the third day the ship made port and the patient was trans- 
ferred to the hospital. At the time of admission the examining surgeon could 
find no signs of acute appendicitis but decided to operate because of the charac- 
teristic history. Operation was performed approximately seventy-six hours 
after the beginning of treatment. The appendix was found to be retrocecal; its 
tip was extremely swollen and engorged, but not gangrenous, and the lumen 
contained fluid which appeared to be purulent. Some difficulty was encountered . 
in removing the appendix because of its position, so it proved fortunate that the 
operation had not been attempted at sea." 

Lt. Riley comments as follows: "Despite the symptomatic and laboratory 
evidence of improvement in this case of acute appendicitis during a seventy- 
six hour period on full sulfadiazine dosage, the appendix on removal appeared 
to be in a highly dangerous state. From the therapeutic point of view this 
would suggest that in medically treated cases of this condition it would b e 
well to continue chemotherapy longer than is indicated by the clinical course. 
Probably a minimum of five to seven days would be adequate." (Atlantic Fleet 
Med. News Ltr No. 12-44, Dec. 10, '44) 

^ ^ ^ 5^ Sjt 3^ 

Arteriovenous Aneurysm : The following is taken from an editorial b y 
Col. Daniel C.'Elkin which appeared in the February 1945 issue of Surgery, 
Gynecology and Obstetrics: 

The' most common lesion resulting from direct injury to blood vessels is 
the establishment of an arteriovenous fistula. This may be produced by the 
smallest of fragments. Since the fistulae may be small and symptomless in 
the early stages, they are often overlooked unless careful examination of every 
wound is carried out. A small missile may produce an external- injury so slight 
as to be regarded as of little importance, but at the same time cause exten- 
sive damage to the underlying artery and vein. 

Frequently patients are treated only for varicose veins and ulcers when an 
arteriovenous aneurysm, responsible for this condition through preventing prop- 
er nourishment of the part, is the cause. Signs of cardiac failure may develop 
before an arteriovenous aneurysm is discovered. The presence of damage to 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

blood vessels may be overlooked in inconspicuous wounds or in wounds involv- 
ing serious injury to nerve, bone or soft tissue, because the attention of the 
examiner is diverted to more conspicuous and seemingly more important le- 
sions. It must be borne in mind that an individual may have more than one 
arteriovenous fistula. 

The differentiation of a false aneurysm from an arteriovenous fistula is im- 
portant, since the sequelae and the general and local effects , as well as the treat- 
ment, are altogether different in the two lesions. The differential diagnosis 
is not always easy, but as a rule the arteriovenous aneurysm is characterized 
by a continuous vibratory thrill and a loud, rough, continuous murmur with 
systolic intensification, whereas in the case of the false aneurysm there is a distinct 
pause between the systolic and diastolic phases, and often the murmur is heard 
only in systole. In an arteriovenous communication the murmur is usually 
transmitted for some distance on either side along the course of the vessels, 
whereas in an aneurysm confined to an artery the murmur is rarely heard 
beyond the confines of the dilatation. 

Certain general and local effects follow the establishment of an arterio- 
venous fistula. These are dependent upon the size of the opening, the vessel 
involved, and the duration of the lesion. Early signs vary. The extent of 
initial external bleeding is variable and can usually be controlled by pressure, 
although in some instances ligation maybe necessary. After an interval of 
time the patient may discover the thrill so characteristic of this condition. 
In other instances it may be found only after careful examination. 

Establishment of a fistula introduces a circuit into the vascular 
system. The peripheral resistance in this circuit is lowered, the capillary 
barrier being eliminated, and arterial blood Is short-circuited directly from 
artery to vein. In a fistula of a large vessel, like the femoral, one-fifth to one- 
half of the blood ejected by the left ventricle may be shunted. If the fistula is 
sufficiently large, enough blood may be diverted into the venous system, proxi- 
mal and distal to the fistula, to produce a general drop in blood pressure and 
even death. In most instances, the blood-pressure changes are not extreme, 
the systolic pressure soon returns to normal, but the diastolic pressure, as' 
a reflection of the general lowering of peripheral resistance, remains lowered. 
The effect on the blood pressure is similar to that seen in aortic insufficiency, 
although in the latter the leak is into the left ventricle while in arteriovenous 
aneurysm it is into the venous system. Increased venous pressure in the cir- 
cuit proximal to the fistula reflects the increased venous filling. The 
accommodates to the increased venous return by acceleration of rate and in- 
creased strength of contraction, effecting an increase in cardiac output. Soon 
an increased circulating blood volume is added as another compensatory mecha- 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

The normal heart usually can tolerate the increased demands made upon 
it, but as the "leak" in the circulation persists, and actually becomes greater 
as the fistula increases in size, difficulties appear. The heart begins to dilate 
and circulatory symptoms appear. Dilatation and later hypertrophy result 
from the increased work the heart is called upon to perform, and circulatory 
failure may supervene. The artery proximal to the fistula dilates, and the 
dilatation may extend as far back as the heart itself. As suggested by Holman, 
this may be caused by the great increase in blood mass in the shorter circuit 
which is the result of the decrease in resistance at the site of the .fistula. 

The immediate effect of temporary occlusion of the fistula is redistribu- 
tion of the circulating blood volume. Blood no longer flows freely through the 
opening into the venous system and therefore temporarily overfills the general 
circulation. The blood pressure rises and the heart may distend. Reflexly, 
via the carotid sinus, the heart is slowed (Branham's sign), and some peri- 
pheral dilatation occurs. Usually, a temporary rise in systolic and diastolic 
pressures occurs. Following excision of the fistula, the diastolic pressure re- 
turns to normal. There may be a temporary increase in size of an already di- 
lated heart, but with return of the blood volume to normal (often after several 
days) the heart returns to its normal size, unless irreparable myocardial dam- 
age has taken place. 

There is no condition which produces such an extensive collateral circu- 
lation as does the interposition of a fistula between an artery and a vein. This 
collateral circulation is of little value when the fistula is open, since most of 
the blood in the collateral vessels passes back through the fistula without 
reaching the part beyond it. However, it is important that sufficient time be 
allowed to elapse prior to operation for collateral circulation to develop, as a 
well-developed collateral system permits excision of the fistula with little 
fear of resulting gangrene. 

The effect on the heart as well as the local effects demand that an arterio- 
venous fistula be eliminated. Time allowed for development of collateral circu- 
lation (two or three months) should not be great enough to allow pronounced 
cardiac damage to occur or nutrition of the part involved to be affected. Mere 
ligation of major vessels will not cure the lesion and more oftenthan not leads to 
gangrene of a limb. On theoretical grounds it would seem best to repair the opening 
in the artery and vein and at the same time maintain their continuity. Such a 
procedure is technically difficult and frequently results in secondary hemor- 
rhage or recurrence of the lesion. Since the collateral circulation is of such 
abundance, quadruple ligation of the proximal and distal segments of' the artery 
and vein and complete excision of the fistula is the method of choice. Where 
technical difficulties preclude this procedure, the fistula may be eliminated by 
ligation and division of the main vessels followed by closure of the communica- 
tion through the opened vein, by the passage of mass ligatures about the area 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

of the fistula, or by separation of the vessels and closure of the opening in 
each. Nutrition of the area distal to the fistula will immediately improve 
since the blood formerly diverted will reach the part through the collateral 

5(c % ^ jje 

The Nature of Post-Traumatic Headache : Extensive studies have been 
carried out on- 35 patients with post-traumatic headache. "With one exception 
the headaches have all been of low intensity, and steady, dull aching in charac- 
ter. The site was commonly in or close to muscle attachments. Several pa- 
tients had a sore spot representing the point of trauma. This point was usually 
two or more inches distant from the center of aching pain. There was great 
variation in the frequency and duration of the headaches and in the time of day 
in which they occurred. Nausea and vomiting were rare. Hyperesthesia and 
photophobia were common. When a tender spot was present, the tenderness 
fluctuated in degree with the severity of the headache. Pressure sometimes 
accentuated the discomfort and sometimes relieved it. Injection of the tender 
spot with procaine uniformly relieved the soreness and the aching pain. Most 
of the patients showed increased irritability and intolerance in their social 
milieu. A sleep disorder was found in nearly all of the patients." (OEMcmr- 
485, Progress Report #1, Wolff, Cornell Univ., CMR Bulletin #25) 

3f: 3(e + + j); 

Suspension-Traction Treatment of Fractures : A recent War Department 
Technical Bulletin discusses the application of suspension traction in the treat- 
ment of fractures, with particular reference to femoral fractures. Especial at- 
tention is called to the value of this form of treatment of fracture of the femur 
during the late as well as during the early stages of bed care. Patients with 
fractures of the femur are usually evacuated from field units to forward hospi- 
tals in the Army leg splint, using the litter bar, ankle strap and five triangular 
. bandages. These patients are evacuated from forward hospitals to fixed hospi- 
tals in the communications zone either in skin or skeletal traction suspended 
and fixed in an Army leg splint or in a plaster hip spica. (The application of 
multiple pins or wires through fracture fragments incorporated in plaster in 
order to maintain reduction is not recommended.) In fixed hospitals overseas, 
fractures of the femur should be treated by suspension traction until sufficient 
union has been obtained to permit safe transportation of the patient to the zone 
of the interior with the fracture immobilized in a double or " one -and- one -half" 
plaster hip spica. After arrival in the hospital in the zone of interior 
in which the patient will remain, the spica cast should be removed and the sus- 
pension^raction treatment again instituted if further immobilization is indicated. 
Plaster immobilization is desirable only for transportation of fractures of the 
femur. The suspension method not only will lead to earlier return of joint motion 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

and muscle strength than any other method, but also is the best means of pre- 
venting angulation and overriding. 

In the definitive treatment of fractures of the femur it is important that in 
the early stages, traction be sufficient to overcome the pull of the strong thigh 
muscles and to maintain the reduction of the fracture, but that this traction not 
be so great that distraction or separation of the fracture fragments occurs. 
This method of treatment requires daily attention to details in order that the 
reduction of the fracture be maintained, that the apparatus be neat in appear- 
ance, and that it be comfortable at all times. 

Skin traction, because of its simplicity and safety, is preferred whenever 
its use is possible. Adhesive tape and gauze bandage are commonly used, but 
a flannel bandage with a skin-adherent is preferred because it is more com- 
fortable and durable. 

After application of the skin- adherent to the unshaven skin, the strips of 
flannel are cut to proper length and applied with the rough side to the skin, 
followed by firm, smooth bandaging. The success of skin traction depends on 
the care with which it is applied. 

Skeletal traction is indicated where skin traction cannot be used, or where 
it will not be effective because of the amount and duration of traction required. 
A Rirschner wire is preferred to a Steinman pin because it is easier to apply 
and produces minimal trauma, but it is imperative that a bow be used which 
keeps the wire under tension. Rotary and lateral motion of the bow must be 
prevented. Solid Steinman pins are at times effective. These do not require 
a bow and are preferred where the patient is, of necessity, to be transported 
in a splint with skeletal traction or with the pin incorporated in a cast. Jointed 
Steinman pins are dangerous and obsolete and should not be used. Ice tongs for 
skeletal traction on long bones are not approved because of the difficulty of satis- 
factorily applying them and the subsequent danger of their slipping and causing 
trauma to soft tissue . The insertion of the pins or wires for skeletal traction or fixa- 
tion should be done under rigid aseptic precautions and preferably in the operat- 
ing room. As far as possible, these pins or wires should not be inserted in the 
vicinity of traumatized skin or in the vicinity of a future operative incision, 
since even a healed pin tract must be considered a site of potential infection. 
Nerves, vessels and joints should be scrupulously avoided. Pins which com- 
pletely transfix the extremity should not be inserted in the humerus or the proxi- 
mal two-thirds of the femur. Obviously, a wire or pin inserted into bone for 
skeletal traction should engage sufficient bone so it will not cut through and 
pull on the soft tissue. 

In treatment with suspension traction, the injured extremity should be so 
suspended in the splint or hammock, and so balanced by weights, that it can 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

move with the movement of the body and still furnish effective immobilization 
of the fracture. Rigid fixation of the extremity to the bed or fracture frame 
is not desirable. Supporting slings should be smooth and well padded, and 
rope knots should be secured, as by adhesive tape. Special attention must be 
given to the position and resulting pressure of the ring when a ring splint is 
used. So far as possible, by adjusting the position of the patient and the bed, 
the weight of the body is used for counter -traction and a minimum of weight 
is applied to hold the splint in position. If a wound is present in the ischial 
region, the half-ring of the splint may be reversed to the front of the thigh. 

A trapeze bar hung on the Balkan frame at the right height to be used by 
the patient in pulling himself up is indispensable as an aid to changing posi- 
tion in bed and nursing care. 

The standard Balkan frame is both adjustable and adaptable. It allows 
the application of any form of traction to from one to four extremities in any 
position desired. 

During the early stage of fracture treatment, active motion must be 
avoided. However, it is desirable that subkinetic muscle contraction, such as 
quadriceps exercise, be instituted early in order to prevent atrophy and 
stiffness. After the fracture of a femur has partially united, support and 
traction are still required, but motion of the knee can be started. This i s 
best accomplished with the use of a Pier son attachment to the Army leg splint 
which allows both active and passive motion of the knee. Traction is to be 
maintained until all support is discarded and free recumbent exercise can be 
practiced. As soon as the degree of union permits, motion of the knee should 
be practiced at regular and frequent intervals. It is urgent that knee motion 
be restored by regular exercise as soon as possible. 

Since the ischial caliper to be worn after the suspension-traction treat- 
ment is discontinued has no joint at the knee, it must be removed regularly 
for exercise of the knee after the patient becomes ambulatory. (TB MED 133) 

While the chain of evacuation described in the above item applies to the 
Army, the fundamental orthopedic principles involved are generally applicable 
and can be adapted to methods of evacuation used in Marine Corps and Amphibi- 
ous operations. 

Whole Blood and Electrolyte Therapy of Experimental Burns : Observations 

on dogs subjected to severe burns (35 to 40 per cent of body surface) suggest 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

that the usual anemia seen during the convalescent stage can be largely pre- 
vented if initial therapy combines transfusion of whole blood and oral adminis- 
tration of electrolyte solution. When such therapy was used, the hematocrits 
were not more elevated than in dogs not treated or treated with plasma. These 
findings are in agreement with observations on patients who, when whole blood 
was given, did not have an anemia during convalescence. When whole blood is 
not given until the convalescent period, more is needed to combat anemia than 
when the blood is given initially. 

In addition data are presented which suggest that to obtain best results 
the oral electrolyte solution should be given early and, if vomiting occurs, the 
intravenous route of administration should be resorted to until fluid can be re- 
tained when given by mouth. (OEMcmr-432, Progress Reports #4 and #5, 
Hirshfeld and Smith, Wayne Univ. - CMR Bulletin #25) 


Biologic False -Positive Serologic Tests for Syphilis : Although it has 
been known for many years that certain diseases and conditions at times' re- 
sult in positive blood tests for syphilis in the absence of this disease, only 
recently has the problem of biologic-false -positive tests and their differentia- 
tion from those due to syphilis become one of general concern. With the wide- 
spread adoption of mass blood testing and with more careful serologic study 
of patients suffering from a variety of disorders, it has become evident that 
false-positive reactions may be observed in healthy as well as ill p e r s o ns , 
and that the differentiation of such false reactions from those due to syphilis 
is often difficult and, with presently available methods, sometimes impossible. 

It is now clearly established that positive reactions occur in almost all 
patients with treponemal diseases (yaws and pinta) , and at least temporarily 
in almost all cases of malaria, while 40 to 80 per cent of leprous patients also 
give positive serologic tests for syphilis. Evidence is accumulating that in cer- 
tain exotic diseases (rat-bite fever, relapsing fever and perhaps leishmaniasis, 
trypanosomiasis and typhus) false-positive reactions may be found, although the 
frequency of their occurrence is unknown. More common diseases and condi- 
tions known to cause similar false reactions include vaccinia (12 to 20 per cent), 
infectious mononucleosis (about 20 per cent), pneumonia (pneumococcal and 
atypical), as well as minor upper respiratory infections. A small number of 
non- syphilitic, presumably normal individuals may be "carriers" of f alse - 
positive reactions for long periods of time - months, years or perhaps for life. 

Particularly in the Armed Forces, the differentiation between positive 
blood tests due to syphilis and those due to other factors has become of para- 
mount importance/ Such differentiation is rendered difficult by multiple im- 
munizations, some of which are known to cause false -positive reactions; by the 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

variety of diseases, tropical and otherwise, known to cause false -positive re- 
actions and to which large numbers of troops are exposed, and by the hi gh 
incidence of syphilitic infections in many areas. 

During the past year, a small group of investigators under OSRD (CMR) 
contracts has endeavored, in collaboration with certain other laboratories, 
including that at the Army Medical School, to study the problem of - false- 
positive serological reactions in an attempt to develop methods of differentiat- 
ing between the "true" and "false" reactions. 

Results: Certain physical and chemical characteristics of the substance • 
responsible for false reactions have been identified, some of which appear to 
distinguish it from the reagin of syphilis: 

(a) By fractional precipitation it is precipitated in fractions of G-I and 


(b) The sum of flocculation titers of globulin fractions of a syphilitic serum 
is less than that of the whole serum, whereas with serum which gives a bio- 
logically false reaction it is greater than that of the parent serum. 

(c) Addition of crude albumin to globulin fractions of sera giving false- 
positive reactions completely prevents flocculation with lipoidal antigen. 

(d) Antibodies in syphilitic sera are more resistant to inactivationbyheat. 

Beard and Neurath summarize as follows the present status of their in- 
vestigative work on this important problem: 

Electrophoresis : Electrophoretic analyses were made on 13 normal, 25 
syphilitic and 4j5 biologic-false-positive sera. Sera from patients with syphilis 
differed from normal sera in decreased albumin and increased gamma- globulin 
content, the difference being both relative and absolute. Biologic-false -positive 
sera showed differences from normal sera qualitatively similar to those of 
syphilitic sera but of smaller magnitude. 

Fractionation: The distribution of the reactive antibodies among the 
various 'serum components has been determined by (a) fractional precipitation 
with increasing concentrations of ammonium sulphate, and (b) precipitation of 
globulin with C02- Analyses of some 200 sera showed (a) that fractions G-I 
and G-II contained most of the serologic activity, whereas crude albumin re- 
maining after precipitation of G-III was always serologically inactive; and (b) 
that the sum total of the individual titers of the syphilitic fractions was less 
than that of the whole serum, whereas with biologically false-positive (BFP) 
sera it was greater than that of the parent serum. This suggested an inhibi- 
tory effect of crude albumin on the reaction of antibodies of BFP sera. 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Inhibition and Redispersion : Addition of crude albumin to globulin frac- 
tions from BFP sera causes complete inhibition of specific flocculation with 
lipoidal antigen as well as redispersion of floccules formed before the crude 
albumin was added. This was not the case with syphilitic sera. The heat- 
stable inhibiting component of the albumin fraction has been found only i n 
human sera. Crystalline human serum albumin does not have this inhibitory 

Feat Stability : Experiments with 50 syphilitic and BFP sera were made 
by heating the samples for 20 minutes at from 56° to -66°. It was found that the anti- 
bodies of BFP sera were more susceptible to heat inactivation than those of 
syphilitic sera. 

Adsorption on Calcium Phosphate : The antibody of syphilis has been puri- 
fied by adsorption of whole sera on freshly precipitated calcium phosphate fol- 
lowed by precipitation of the eluate with ammonium sulphate. While about 80 
per cent of the total antibody activity of syphilitic sera is adsorbed by the cal- 
cium phosphate, in experiments with BFP sera no titer has been found in the 

These studies indicate the existence of chemical and immunological dif- 
ferences between syphilitic and BFP sera. The application of these findings 
to the development of a practical method of differentiation is being explored. 

On the basis' of these results a test has been devised using small amounts 
of serum to discriminate between true and false-positive serological reactions. 
It is expected that preliminary validation studies involving, tests of 'known BFP 
sera of various titers will be completed within three months. With the coopera- 
tion of the Army, of various clinics, and of the officers of the United States Public 
Health Service in Puerto Rico, several hundred BFP sera are being collected 
for examination. (OEMcmr-255, Duke Univ.) 

* * 

Other investigations carried on by Lund may be summarized as follows: 

Work originally directed at determining the distribution of reagin-like 
substances in the general population in the absence of syphilitic disease indi- 
cated that a reacting substance was present in low concentration in about 50 
per cent of the population, more commonly in young people and females. The 
substance was different from the reagin of syphilis and was less constantly 
present; it deteriorated more rapidly. It was heat labile, somehow related 
to cold temperature and more readily adsorbed to cholesterol crystals. It 
did not perceptibly fix complement by ordinary technics , but its flocculation was 
inhibited by complement. The false reactions were more common and stronger 
with the separated euglobulins of the serum. 

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Burned News Letter, Vol, 5, No. 5 RESTRICTED 

Studies of the nature of inhibition by raw serum inhibitor, the basis, of 
Rein's 'Verification" test, showed the substance responsible probably to be . 
complement. No qualitative difference in this phenomenon was noted with 
false-reacting sera and syphilitic sera. There may be a quantitative or a 
zonal difference. (OEMemr-202, Western Reserve Univ.) 

Salmonellae: Animal Source : Animals are the main reservoir of Salmonel- 
lae. Salmonellosis may be transmitted to man following the ingestion of inade- 
quately-cooked food substances from animals which are infected. The meat of 
fowls (chickens, turkeys, ducks, etc.) is the most frequent source of infection 
of man. A recent survey has revealed that 41 of the 47 types of Salmonellae 
found in birds correspond to types isolated from man. 

Commissaries customarily receive fowls that have not been drawn. Prepa- 
ration of birds for cooking and the cooking process itself must, therefore, be 
.carefully and adequately done, since Salmonellae are to be found mainly in the . 
visceral organs. 

A little known but important means of spreading and perpetuating Salmonel- 
lae is the transmission of infection through eggs. Eggs may become infected in 
the ovaries and oviducts of birds harboring the organisms or through penetra- 
tion of the unbroken shell by organisms in fecal matter which is deposited thereon. 

The finding of certain types of Salmonellae in egg powder suggests that 
this food substance should be used only after it has been found to be bacterio- 
logically safe or after it has been subjected to cooking processes which are 
adequate to destroy the bacteria. The methods now employed in the manufac- 
ture of egg powder obviously do not eliminate these' organisms. CNav. Med . 
School, Bethesda, Md. - L. A. Barnes) 

Enteric-Pathogen Survey : In several items during the past twenty months 
attention has been called to the importance of obtaining accurate identification 
and cataloguing of bacillary incitants of diarrhea and dysentery. Facilities for 
centralizing this service have been provided by the establishment of the Enteric - 
Pathogen Laboratory, Naval Medical School, Bethesda, Maryland. There is 
need for more information concerning the incidence and prevalence in the vari- 
ous geographic localities, particularly the combat areas, of the types of Shi gellae 
and Salmonellae; similar data are highly desirable with regard to members of 
the Paracolon, Proteus and Pseudomonas groups. 

Certain laboratories in the field have obtained Shigella Diagnostic Sera 
from the Medical Supply Depot in Brooklyn, New York. Typing sera for the 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 








(If more than one attack occurred, fill out ADDITIONAL SHEETS for the Information 

helow and clip to the original) 





















- 21 - 

(L. A. Barnes) 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

other genera mentioned are not, however, generally available at present. Re- 
gardless of whether organisms belonging to the enteric -pathogen group have 
been typed by epidemiology, hospital or other laboratories, the Naval Medical 
School desires that adequately representative cultures be forwarded for In- 
clusion in cataloguing and analyzing procedures. 

It is essential that cultures sent by mail be packaged in conformity with 
Postal Regulations in order to ensure delivery of intact specimens. 

if full value is to be realized from type identification, clinical and epidemio- 
logical data concerning the cases from which cultures are isolated must be for- 
warded with the official letter of transmittal. Such information will be trans- 
scribed to punch cards for statistical analysis. The importance of collecting 
the materials described has been previously emphasized CBuMed Circ. L t r . 
Y-ME, P2-3/P3-1C064); Burned News Letter, Sept. 1, '44). Cooperation is re- 
quested of all officers in charge of laboratories equipped to carry out definitive 

A case-history sheet, or card, providing for the entry of the desired infor- 
mation is being used with considerable success; a sample is reproduced on page 
21 as a suggestion. (Nav. Med. School, Bethesda, Md. - L. A. Barnes) 

SfC 5^C ifc 3|c sfc 


Method of Distribution of Training Films: When a training film- has been 
evaluated by the Joint Board of Review, a recommendation on distribution i s 
made to the Distribution Unit, Production and Distribution Section of the Bureau 
of Naval Personnel. This Unit then prepares requests to the Bureau of Aero- 
nautics for initial distribution of the film. A large proportion of the prints are 
sent to Training Aids Sections and Libraries, which handle virtually all distri- 
bution to ship and shore activities. In certain instances activities may receive 
films by direct application to BuAer. Training Aids Sections and Libraries 
submit requests 60 days in advance of their requirements in order that BuAer 
may meet their needs. 

Reports of films on hand are submitted periodically by the Sections and 
Libraries. This enables the Distribution Unit to transfer surplus stock from 
one district to another without delay. 

All requests for 16-mm. motion picture projection equipment, 35-mm. 
film strip equipment, and record players are submitted through the Distribu- 
tion Unit. The projectors, both still and motion picture, are supplied byBuShips 
upon approval by BuPers. The record players are supplied by BuPers. (Prev. 
Med. Div., BuMed - C. C. Clay) 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Maritime Quarantine with Reference to Naval Vessels : The Bureau has 
received a number of complaints from quarantine officers of the U. S. Public 
Health Service relative to naval vessels, with a medical officer aboard coming 
into ports of the United States without passing through quarantine when such 
was indicated. 

The mere presence of a medical officer on a naval craft does not exempt 
it from the necessity of being boarded by a quarantine officer. TheU. S. Public 
Health Service has been most liberal in its interpretation of the regulations in 
order to accommodate naval vessels. However, there are a number of condi- 
tions under which naval vessels with medical officers aboard must be granted 
pratique by a quarantine officer before they may legally enter a port of the 
United States. In particular, these are conditions in which a vessel has been 
in port where.a quarantinable disease exists and where communication has been 
of a type liable to convey infection. Under conditions where vessels are in such 
ports, unless specific procedures have been carried out which render the vessel 
not liable to convey infection, they must enter quarantine before coming along- 
side in a port of the United States. Attention is invited to General Order No. 157 
and Navy Department Bulletin, Cumulative Edition, Dec. 1943, 43-1616. Unless 
the medical officer can under oath subscribe to either the first or the second 
statement of paragraph 3 of this general order in his declaration, the "Q" flag 
must be flown. 

Violation of quarantine laws and regulations i s classified as extremely 
serious offenses and in view of the fact that the U. S. Public Health Service 
has permitted the Navy to assume a considerable share in the enforcement of 
quarantine regulations, a heavy obligation rests on Naval personnel to live up 
to the spirit and the letter of the law. 

For the benefit of medical officers in the Navy the following summary of 
Maritime Quarantine Regulations follows: 



The following naval vessels must fly the "Q" flag on entering any port in 
the. United States, its territories or possessions and be boarded by an officer 
of the U. S. Public Health Service or by an U. S. Navy Quarantine officer where 
one is present: 

1. Those without a medical officer (physician) aboard or in the convoy or 

(A) From any foreign port. 

If a vessel calls at a foreign port before or after calling at a non-continental 
United States port, it is considered to be from a foreign port. If the vessel does 

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Burned News Letter, Vol. 5, No. 5 


not officially enter or clear a foreign port and has no contact with the shore 
except for purposes of receiving orders or the taking on of bunker oil or neces- 
sary sea stores or was in distress or, because of any other emergency, does 
not remain longer than 24 hours, it is not considered to have called at the port 
in question. The following countries and possessions are not considered to be 
foreign but are considered to be domestic ports for terms of quarantine: 

Canada West Coast of Lower California 

Ala'ska Bahama Islands 

Territory of Hawaii Cuba 

Bermuda Canal Zone 

Puerto Rico San Pierre 

Virgin Islands Miquelon 


(B) From any domestic port declared to be infected with quarantinable 
disease. At present these are: 

Tacoma, Washington Hilo, T. H. Kahului, T. H. 

(C) If a person aboard has or is suspected of having a quarantinable- dis- 
ease (cholera, plague, exanthematous typhus, smallpox, yellow fever, or leprosy 
in an alien) . 

(D) For the purpose of rat inspection if the vessel has been In a suspected 
plague port within 60 days. At present these ports are: 

(a) (a) All South American ports. 

(b) All ports in Africa and the adjacent islands of Azores, Maderia, 

Canary, Cape Verde, and Madagascar. 
Cc) All Asiatic ports and ports of Hainan and Ceylon and other adjacent 


(d) All ports of Dutch East Indies. 

(e) All ports on the Islands of Hawaii and Maui. 

(f) The European-Mediterranean ports of Spain, France, Greece, 
Malta and Istanbul. 

(g) Noumea, New Caledonia. 

(h) Tacoma, Washington. 

2. Those with a medical officer (physician) aboard or in the convoy or squadron. 

(A) From any port, foreign or domestic, where quarantinable disease exists 
and communication has been of a type liable to convey infection. Communication 
has not been "of a type liable to convey infection" in the following instances: 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Cholera: Provided that Army, Navy or ships' personnel have been inocu- 
lated against cholera or such personnel have not been allowed liberty i n ports 
where cholera is known or suspected to exist; provided further, that no water 
supplies or only water supplies known to be cholera-free have been taken in 
such ports, and provided further that fresh food stores such as vegetables and 
fruits to be eaten raw have not been taken in such ports. 

Yellow Fever: Provided that Array, Navy or ships' personnel of vessels 
calling at ports known or suspected of being infected with yellow fever have 
been inoculated against yellow fever; and provided that the vessel has remained 
at anchor not less than 200 meters from the nearest shore; and further provided 
that all necessary precautions have been taken to prevent the breeding of Aedes 
aegypti mosquitoes aboard the vessel. 

Typhus : Provided that Army, Navy or ships' personnel of vessels calling 
at ports infected with exanthematous typhus present in epidemic form have 
been inoculated against typhus; and further provided, that such personnel are 
known to be louse-free. 

Smallpox : Provided that Army, Navy or ships' personnel of vessels call- 
ing at a port suspected of having smallpox present in epidemic form have not 
been allowed liberty or have had smallpox or have been successfully vaccinated 
against smallpox within the past three years. 

Plague: Provided that the vessel has remained at anchor during its stay 
in a port known or suspected of being plague -infected or has enforced and 
maintained adequate measures to prevent rat infestation, has not taken aboard 
rat -attractive or rat-harboring cargo or stores and is in fact rat -free. 

(B) If a person aboard has or is suspected of having a quarantinable dis- 
ease (cholera, plague, exanthematous typhus, smallpox, yellow fever, or lepro- 
sy in an alien) . 

CO For the purpose of rat inspection if requested by the medical officer. 

3. All other naval vessels with or without a medical officer (physician) aboard 
will neither fly a "Q" flag nor request pratique. Those vessels having a medi- 
cal officer aboard and from a foreign port and under conditions other than indi- 
cated in paragraph 2 will forward all duplicate Bills of Health and a modified 
quarantine declaration certificate (Navy Department General Order 157) to the 
"Quarantine Officer, U. S. Public Health Service" of the local port of entry or 
the nearest port in which a U. S. Public Health Officer is located within 24 hours 
after arrival; where arrangements have been made, the report may be forwarded 
via the District Medical Officer. (Capt. T. B. Magath, MC(S), USNR - Navy 
Quarantine Liaison Officer) 

Burned News Letter, Vol. 5, No. 5 


Infections Due to Staphylococci Resistant to Sulfonamides and Penicillin: 
"Sulfonamide -resistant strains of coagulase-positive staphylococci are being 
recovered with increasing frequency from patients. This resistance appears, 
as far as has been observed, to be a permanently acquired characteristic and 
the development of resistance is not associated with diminution in virulence. 

"Coagulase-positive strains of staphylococci are occasionally encountered 
which possess, a natural resistance to penicillin. While this biological phe- 
nomenon may be conducive to therapeutic failures with penicillin, the resist- 
ance is relative, and may be overcome with adequate doses of penicillin. For 
this reason, it is recommended that adults having severe staphylococcal infec- 
tions should receive a minimum of 200,000 units of penicillin per 24 hours dur- 
ing the initial stages of therapy. 

"Coagulase-positive strains of staphylococci may acquire resistance to 
penicillin in vivo and in vitro. Fortunately, the development of such resistance 
appears to be a minor cause of failure with penicillin. The resistance to peni- 
cillin which has been developed by in vitro methods may not be a permanent 
property of the organisms, and strains with increased resistance are more 
susceptible to the killing action of human whole blood in vitro. Further in- 
vestigations are necessary to determine if resistance acquired as a result of 
therapy becomes a permanent characteristic of the organisms. 

"Strains of coagulase -positive staphylococci may show a natural resist- 
ance to penicillin, but marked sensitivity to sulfathiazole or sulfadiazine. In 
view of this, a combination of penicillin and sulfonamide therapy might be in- 
dicated in the treatment of selected patients." (Spink, Hall and Ferris, Univ. 
of Minnesota j CMR Bulletin #24. - To be published.) 


Bacteriolytic Action of Penicillin: The action of penicillin o n bacteria 
has been attributed mostly to its bacteriostatic activity. 

In a recently published paper, Todd calls attention to early observations 
by Fleming that bacteriolysis is exhibited by certain bacteria in the presence 
of penicillin, and he has conducted experiments, using several organisms, to 
observe the effect of penicillin on them in culture. 

All of the penicillin-sensitive organisms tested showed bacteriolysis in 
the presence of penicillin. All penicillin-resistant organisms tested failed to 
show lysis. Bacteriolysis appeared to be dependent on the phase of growth of 
the organisms and its rate depended on the rate of multiplication. Old cultures 
in a resting state not only failed to show bacteriolysis but also in certain in- 
stances resisted the bacteriostatic and bactericidal activity of penicillin. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

It would appear that bacteriostasis, bactericidal action and bacteriolysis 
may be different stages of a single process proceeding in that order. The fact 
that the most rapid and complete lysis occurs with organisms at the maximal 
rate of multiplication suggests a possible explanation of the great effectiveness 
of penicillin in treatment of the invasive stage of acute infections. (Lancet, Jan. 
20, '45) 


Professional Qualifications Card ; Professional Qualifications Cards were 
mailed to all medical officers with the Burned News Letter of November 24, 1944. 
In a letter which accompanied the form, medical officers were directed to fill 
out the information requested thereon and return the card as promptly as possi- 
ble to the Bureau. It is urgently requested that medical officers who have not 
filled out their Professional Qualifications Cards do so as soon as possible. 

The information contained on this card is of direct importance to each medi- 
cal officer as it is used in determining his fitness for various types of duty. If 
any medical officer failed to receive a Professional Qualifications Card, he may 
obtain one on application to the Bureau of Medicine and Surgery. (Prof. D i v . , 
BuMed - G. C. Thomas) 

* a|e s(e j|c * * 

" Malaria and Epidemic Disease Control Training Manual No. 6 - Filariasis ■ 
Epidemiology and Control " (Restricted) compiled byLt. Byrd and Lt. (jg) 
St. Amant - for Medical and Epidemic Disease Control Officer, SoPac area - 
November 1944, is available in limited quantities. Interested personnel may 
obtain this manual on request from Malaria and Epidemic Disease C o ntr ol 
Officer, SoPac Headquarters, Navy 131. 

The Bureau of Medicine and Surgery has no copies for distribution at this 
time. (Prev. Med. Div., BuMed - H. P. Hopkins) 

Immune Serum Globulin : The globulin prepared for the Navy as part of its 
Plasma Fractionation Program and used in the. prevention and treatment o f 
measles bears the official National Institute of Health name, Immune Serum 
Globulin (Human) . 

In the M e d i c a 1 Supply Catalog and on several lots received from 
one manufacturer the term, M^ asj - es Immune Serum Globulin (Human) is used. 
Attention is called to the fact that these two names refer to the same product. 
(Nav. Hosp., Bethesda, Md. - S. T. Gibson) 

- 27 - 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

Submission of Annual Sanitary Reports Via Official Channels: Annual 
sanitary reports from several Naval and Marine Corps activities have been 
forwarded to BuMed without having been routed through official channels for 
proper endorsement. Attention of originating activities is invited to Par. 2691 , 
Manual of the Medical Department, relative to submission of annual sanitary 
• reports. (Prev. Med. Div., BuMed - T. J. Carter) 

j)t +: 3fc =je % 

Bite Patterns of Snakes : In most recent articles on snake bite it has been 
stated that a pit viper (rattlesnake, copperhead or water moccasin) in biting 
makes only one or two large punctures, in contrast to a harmless snake which 
makes several rows of small punctures. The reason for this was said to lie 
in a difference of the behavior of the two types of snake, i.e., the pit viper 
merely stabs with its pair of long fangs, whereas the harmless snake actually 

By allowing representative species of the two types of snake to bite plastic 
cylinders or gelatin models of hands wrapped in thin paper, Pope and Perkins 
have shown that the pit vipers of the United States bite rather than stab and 
leave impressions of their teeth as well as their fangs. Since all the teeth in 
any one of the harmless snakes in the United States which is big enough to bite 
are usually similar in size, structure and shape, most of them come into play 
during the act of biting and, in a perfect bite, leave six rows of punctures, four 
rows in one group and two in the other (Fig. A). In the pit vipers, the outer row 
on each side of the upper jaw has been reduced to a single large, erectile, hol- 
low tooth - the fang. The bite of a pit viper, therefore, should leave not more 
than four, rows of punctures in addition to the two large perforations made b y 
the fangs (Fig. B). 

A B 

Diagrams of almost perfect bite patterns of a poisonous and a harmless 
snake. The stippled areas indicate the approximate positions of the pockets 
of injected venom. Fig. A - western diamond-back rattlesnake. Fig. B - 
bull snake. (Arch. Surg., Nov. '44) 

- 28 - 

Burned News Letter; Vol. 5, No. 5 


To: All Ships and Stations. Opl3-lD-jc 

Serial 60613 

Subj: Medical Department Facilities at the Naval 12 27 14 

Training Center, Great Lakes, Illinois. 5 Jan 1945 

1. The Naval Dispensary at the Naval Training Center, Great Lakes, Illinois 
(Camp Mclntire), and the entire facilities of Camp Lawrence at the Naval 
Training Center, Great Lakes, Illinois, are hereby transferred to the adminis- 
trative command of the U. S. Naval Hospital, Naval Training Center, Great 
Lakes, Illinois, for use for naval hospital purposes and as a receiving and dis- 
tribution center for patients. 

2. Bureaus and offices concerned take necessary action. 

--SecNav. James Forrestal. 


Subj: Handling of Beer and Ale. BuPers. 1 Jan 1945 

Alnav 208 is modified as follows: "The provisions of Alnav 208 shall not 
apply in naval hospitals or on naval hospital reservations." 

--SecNav. James Forrestal. 

To: All Ships and Stations. BUMED-ECB-MLM 


Subj: Hospital Ticket - Women, NAVMED 416. 20 Dec 1944 

Encl: (A)Copy of NAVMED 416. 

1. Subject form is now available at the Naval Medical Supply Depot, Brooklyn, 
New York, and Naval Medical Supply Depot, Oakland, Calif. Sample of this 
form is enclosed. 

2. Hospital Ticket - Women, NAVMED 416, is similar to the Hospital Ticket - 
Men, NAVMED Form G, but lists the personal effects for women. 

3. Supply of these forms may be ordered on Medical Supply Depot Requisition 
NAVMED 4. Catalogue listing will be as follows: 

SI 6- 222 NAVMED 416 Hospital Ticket - Women 50 in pad. - 

--BuMed. Ross T. Mclntire. 

- 29 - 


NAVMED — 41fl (8-44) 



The following named patient with her Health Record, necessary transfer papers (Supers Manual), and effects, inventoried under my supervi- 
sion and certified to be correctly listed below, is hereby transferred to yourcharge. 


DIAGNOSIS (from Nomenclature) 








































































{MC) U. S. W. 


V. S. N., Commanding. 

I Certify that my personal effects as listed above have been returned to me, 


(Signature of patient) 



Burned News Letter, Vol. 5, No. 5 RESTRICTED 


Subj: Identification of Bodies. BuMed. 6 Jan 1945 

To facilitate and expedite identification of unknown bodies it is directed 
that rolled impressions of all 10 fingers if possible or of all available fingers 
be submitted to BuMed on Form BNP680, NAVMC 330-PD, or on blank sheet 
with each digit properly marked. Submission of one fingerprint as required 
on NavMed Form N not sufficient in most cases for practical search. 

--SecNav. James Forrestal. 


To: All Ships and Stations. Pers-66-IG 


Subj: Enlisted Personnel of the Active List Disabled for 

General Service, Disposition in the Case of. 15 Jan 1945 

Refs: (a) BuPers- BuMed joint ltr, relative to enlisted personnel of the active 
list disabled for general service; N.D. Bui. of 30 Nov 1944, 44-1345. 
Cb) BuMed-BuPers joint ltr of 28 Oct 1942; N.D. Bui. Cum. Ed. 1943, 
42-923, p. 1162. 

1. Reference (a) is hereby canceled. 

2. By such cancelation, reference Cb) remains in effect and the procedures 
outlined therein will be followed. --BuPers. L. E. Denfeld. 


To: All Ships and Stations. , Pers-2111-FBH 


Subj: Qualification for Submarine Medical Officer and 

Authorization to Wear the Submarine Medical Insignia. 6 Jan 1945 

Ref: (a) BuPers Manual, art. E-1314, as revised by Man. Circ. Ltr 44-44; 
N.D. Bui. of 31 Jul 1944, 44-883. 

1 . It has come to the attention of this Bureau that many articles or reports 
and examination papers submitted by medical officers as a part of the require- 
ments for designation as "Submarine Medical Officer" are below the standards 

- 31 - 

Burned News Letter, Vol, 5, No. 5 RESTRICTED 

required. Articles submitted by applicants for designation as 1 'Submarine 
Medical Officer" in accordance with the requirements of reference (a) to the 
Central Board of Medical Officers clearly reflect, in many instances, that 
little time or effort has been devoted to their preparation. Articles or re- 
ports are desired which yield original and important information on the sub- 
ject of submarine and diving medicine and are to be written with due effort 
and thought. The subject, matter which they cover should be of such nature 
as to furnish a significant contribution to this specialized field of medicine. 

2. The unauthorized wearing of the submarine medical insignia has come to 
the attention of this Bureau. Medical officers are advised that the wearing 
of the submarine medical insignia must be authorized by letter from the 
Chief of Naval Personnel and that such officers must meet the qualifications 
as outlined in reference (a) . 

3. For information as of the date of this letter, this Bureau has authorized 
the following-named medical officers to wear the submarine medical insignia: 

ADAMS, Benjamin EL, Capt. (MC), USN 
BATEMAN, James G., Lieut. (MC), USN 
BEHNKE, Albert R., Comdr. (MC), USN 
BRINTON, Edward S., Lieut. (MC), USN 
BROWN, Ernest W., Capt. (MC), USN 
BURMAN, Richard G., Lieut. MC-V(G), USNR 
CHRISM AN, Allan S., Comdr. (MC), USN 
COLE, Gillon M., Lieut. (MC), USN 
DUBOIS, Eugene F., Capt. (MC), USNR 
DUFF, Ivan F., Lieut. MC-V(G), USNR 
ECKBLAD, Gordon H., Comdr. (MC), USN 
FRANCIS, William S., Lt. Comdr. (MC), USN 
HAYTER, Robert, Lieut. (MC), USN 
HOLLER, Moffitt K., Lieut. (MC), USN 
KELLAR, Robert J., Lieut. (MC), USN 
SHILLING, Charles W., Capt. (MC), USN 
STAINBACK, William C, Lieut". (MC), USN 
STORCH, Raymond B., Capt. (MC), USN 
VAN DER AUE, Otto E., Comdr. (MC), USN 
WELHAM, Walter, Lt. Comdr. (MC), USN 
WILLMON, Thomas L., Comdr. (MC), USN 
YARBROUGH, Oscar D., Comdr. (MC), USN 
YOUNG, Mark I. H., Lt. Comdr. (MC), USN 

--BuPers. L. E. Denfeld. 

5fc ^ sjc sf; ^ 

Burned News Letter, Vol, 5, No. 5 



All Ships and- Stations . 



Laundry - Use of Salt Water in Washing Machines 
on Naval Vessels. 

5 Jan 1945 

Refs: (a) BuShips ltr JHK336), EN28/A2-11, of 28 Jul 1944; N.D. Bui. of 
31 Jul 1944, 44-886. 

(b) BuShips Spec. 51S47(INT), of 1 Apr 1944, "Soap, Salt -Water, 
Powdered (for Use in Soft, Hard or Sea Water)". 

1. Reference (a) discussed the use of salt-water powdered soap in laundries 
on naval vessels. 

2. In order to use salt water safely and satisfactorily in washing machines on 
naval vessels, the following precautions must be observed: 

(a) Salt water must not be used when the vessel is in polluted waters and 
therefore should be used only when the vessel is outside the 50 -fathom curve, 
or 25 miles from shore. 

(b) The fresh-water inlet to the washing machine must be above the over- ■ 
flow level in the washing machine (door opening) . This is necessary in order 
to insure that salt water will not be siphoned back into the fresh-water system 
through a leaky or open valve if pressure is lost in the fresh- water system. 

(c) There must be no interconnection between the piping of the fresh- 
water system and the salt-water system. 

(d) A vacuum breaker must be connected to the steam line through which 
steam is injected into the bottom of the washing machine for heating the water. 
This vacuum breaker should be connected to the steam line back of the first 
shut-off valve at an elevation above the overflow level of the washing machine. 

3. If it is desired to provide salt-water connections to the washing machine 
the work should be accomplished in the various types of installations as fol- 
lows: (no shipalts will be issued) 

(a) Size 20" x 20" washing machines (used on small vessels) - Provide 

a salt-water faucet in order that salt water may be introduced into the machine 
by means of a bucket. 

(b) Washing machines with present fresh-water inlet connections below 
the overflow level (door) - Make a new fresh-water inlet connection above the 
overflow level, and use present, water inlet connections for salt water. 

(c) Machines with two fresh-water inlet connections - If these inlet con- 
nections are above the overflow level, one of these may be used for the fresh- 
water connection and one may be used for salt-water connection by removing 
the interconnecting piping. If they are not above the overflow level, new 
fresh-water inlet connection must be made and the presently installed inlet 
connections used for salt water. 

Burned News Letter, Vol. 5, No. 5 


(d) Machines with one fresh-water connection above the overflow level- 
Add a new salt-water inlet connection. 

Ce) The new inlet connections may be made on the ends of the machine 
except on a double end drive. As a general rule double end drive machines 
have two water inlet connections at present. The new connection must be of 
such construction that it will not interfere with the rotation of the cylinder. 
Since it is above the overflow level, it need not be entirely watertight. 

(f) The salt-water line should be approximately the same size as the 
fresh- water line and fitted with suitable valve. 

(g) A vacuum breaker should be connected to the steam line as discussed 
in paragraph 2(d) herein. 

4. Heaters for salt water will not be provided at present. The salt water in 
the washing machine can be heated by injecting steam into the bottom of the 
washing machine, as presently provided for. 

5. An approved salt-water soap is currently procured under reference (b) 
and is carried in Standard Stock at various naval supply depots under Stock 
No. 51-S-1790. --BuShips. W. F. Christmas. 

To: All Ships and Stations. BUMED-RP-IMB 


Subj: Information and Instructions Relative to Transfer PERS-651-ap 
of Enlisted Personnel to Naval Hospitals or Hos- P16-3/MM 
pital Ships for Treatment, or to Receiving Ships 9 Jan 1945 
or Receiving Stations Upon Completion of Hospi- 
talization, Concerning Disciplinary Action Taken 
or Pending. 

1 . A great number of reports of medical survey received in the Bureau of 
Naval Personnel contain incomplete entries relative to the disciplinary status 
of the personnel concerned and do not give sufficient information to show def- 
initely if disciplinary action has been initiated, completed, or partially com- 
pleted for the offenses noted. Such incomplete information causes much unnec- 
essary correspondence by the Bureau of Medicine and Surgery and the Bureau 
of Naval Personnel. 

2. To eliminate this condition it is directed that hereafter when enlisted 
personnel are transferred to a naval hospital or hospital ship, complete infor- 
mation regarding their disciplinary status shall be furnished the hospital or 
hospital ship. This shall be in the form of a special report signed by the 
commanding officer. It shall be forwarded in duplicate together with the Hos- 
pital Ticket (NavMed-G or 416) and securely attached thereto. It should include 

- 34 - 

Burned News Letter, Vol. 5, No. 5 


information as to any action pending, the date and nature of the offense, whether 
trial has been held, and if so, the sentence imposed, any mitigating action, and 
the date of approval together with the portion of sentence served, if any. If no 
disciplinary action is pending, a signed statement to that effect shall be made. 

3. When enlisted personnel are received in a naval hospital or onboard a hos- 
pital ship, their papers will be -checked immediately to assure that there is 
attached thereto a statement showing the disciplinary status of such personnel. 
One copy of this statement should be made available to the attending medical 
officer for attachment to the clinical record of the individual concerned and 
thus made readily available in the event the individual is brought before a 
board of medical survey. In the event such a statement is not received with 
the patient, it shall be requested immediately from the activity effecting the 
transfer . 

4. When a report of medical survey is submitted to the Bureau of Medicine 
and Surgery, great care shall be exercised to-assure that full information re- 
garding the person's disciplinary status is shown therein. 

5. If an enlisted person who is awaiting disciplinary action is transferred, on 
completion of hospitalization, to the nearest receiving ship or receiving sta- 
tion or other naval activity to await instructions as to further disposition, 
such enlisted person shall have such disciplinary action held in abeyance 
pending action by the Bureau of Naval Personnel and the Bureau of Medicine 
and Surgery on the recommendation of the Board of Medical Survey. 
--BuPers. L. E. Denfeld. --BuMed. Ross T. Mclntire. 

* * * * * * 


Subj: Dating Period of Human Serum Albumin, BuMed. 8 Feb 1945 
Extension of. 

The National Institute of Health allows a five year dating period for normal 
human serum albumin SI -1945. All serum albumin now in stock which has . 
expiration ending any time in the years 1945 1946 or 1947 should be extended 
two years. 

The dating period may eventually extend beyond five years, therefore 
human serum albumin should not be discarded without first obtaining instruc- 
tions from Bureau of Medicine and Surgery. — SecNav. James Forrestal. 


- 35 - 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

ALNAV 12 (45-65) 

Subj: Marriages, Nurse Corps. BuMed. 19 Jan 1945 

Provisions paragraph 451 E, Manual Medical Department, suspended for 
duration war. Effective 10 January 1945 resignations of members of Navy 
Nurse Corps or Naval Reserve Nurse Corps will not be accepted and discharge 
accomplished solely because of marriage. --SecNav. James Forrestal. 

To: All Ships and Stations. BUMED- C- LET 


Subj: Navy Nurse Corps, Marriage of Officers of. 23 Jan 1945 

Ref: (a) Alnav 12-45; 45-66, above. 

1. By suspension of the provisions of par. 451(e), Manual of the Medical De- 
partment, reference provides for continuing in the Nurse Corps officers 
thereof who marry. The following instructions are issued pursuant to this 
change in policy: 

(a) An officer of the Navy Nurse Corps or Naval Reserve Nurse Corps 
whose surname is changed by reason of marriage or divorce shall submit in 
duplicate to the Bureau of Medicine and Surgery via official channels a re- 
quest that her name be changed on the official Navy records. The request 
shall state full name prior to the marriage reported (as Mary Jane Doe) and 
the full married name (as Mary Jane Rowe), and shall be signed by the name 
as given in her appointment to the Nurse Corps. The full name of the husband 
shall be stated and, if in the military service, his rank or rate and branch of 
service shall be given. In cases of change of name by divorce, present and 
former names shall be similarly stated and the request similarly signed. 
The endorsement of the request by the commanding officer should show that 
the records under his cognizance have been changed to accord with the change 
in marital status. 

(b) After request for change of name by reason of marriage or divorce 
has been submitted to the Bureau as provided for above, the officer thence- 
forth will be known and recorded in all official communications by the name 
so reported. Receipt of the request will not be acknowledged nor will action 
be taken by the Bureau other than to effect the necessary changes in records. 

(c) There shall be forwarded with the letter request for change of name 
a properly executed beneficiary slip and a copy of the marriage certificate 
or divorce decree certified to under seal by the clerk of records of the place 
where such certificate or decree was issued. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

2. When it shall be determined that an officer of the Nurse Corps is or has 
been pregnant in the naval service, the following procedure shall be adopted 
to effect separation from the service: 

(a) The officer concerned shall be requested to address a letter of resig- 
nation to the Surgeon General via official channels. This resignation may 
reference this letter as the reason for its tender. 

Cb) There shall be enclosed with this letter of resignation the certificate 
of a naval medical officer as to the existence of pregnancy. The certificate of 
a civilian physician will not be accepted. 

(c) These papers shall be forwarded with utmost dispatch to the Surgeon 
General via official channels. 

(d) If an officer who is or has been pregnant while in the naval service 
refuses to submit her resignation, a detailed report of the case, including the 
certificate of a naval medical officer, shall be forwarded to the Surgeon Gen- 
eral via official channels as soon as practicable. 

(e) Action will 'normally be taken in such cases by letter. 

Cf) Officer of the Nurse Corps separated from the service under the pro- 
visions of this letter shall not be eligible for reappointment. 

3. Existing regulations and directives governing the administration of the 
Nurse Corps shall continue to apply equally to all officers of the Corps. There 
fore, commutation of quarters is not authorized for married officers of the 
Nurse Corps except where public quarters are not available. Married nurses 
will have the same status relative to assignment and commutation of quarters 
as single nurses. 

4. It is desired that all officers of the Nurse Corps be informed of the con- 
tents of this letter in order that they may be fully aware of their responsibil- 
ities, the type of separation involved, and the provisions for their welfare. 

--BuMed. W. J. C. Agnew. 

jjc sje 

To: All Ships and Stations. BUMED- ECB 


Subj: Modification of Usage in Identifying Medical 

Department Forms and Publications. 27 Jan 1945 

Ref: (a) Ltr BuMed-ECB-FAS-A3-3/ENlO(064) , of 14 Dec 1944; N. D. Bui. 
of 15 Jan 1945, 45-23. 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

1 . Enclosure (B) of reference (a) listed Medical Department forms and pub- 
lications (exclusive of those used for internal administrative purposes in 
BuMed) . 

2. Amend said enclosure such that titles of forms and publications indented 

Vi£it*p wi^Ti T*pprt 

as folloWS" 

IN A V lvii-J XJ 


Health Record (Medical History) 



Report of Medical, Dental and Hospital Treat- 

ment, etc. 



Liberty List 



Biographical Inventory-Key X 



Biographical Inventory-Key Y 



Biographical Inventory-Key Z 



Medical Questionnaire for Applicants for the 

Nurse Corps of the U. S. Navy and U. S. 

Naval Reserve 



Handbook of the Hospital Corps, Addendum 



Lightning Can Strike You Twice 

--BuMed. W. J. C. Agnew. 


To: All Ships and Stations. BUMED- Y-DFS 

P3-3/P3-1 (054-40) 

Subj: Roentgenographic Examinations of the Chests 

o£ Navy and Marine Corps Personnel. 4 Jan 1945 

Ref: (a) BuMed ltr P3-3/P3-K054-40) ', of 13 Jun 1944; AS&SL Jan-Jun 1944, 
44-741, p. 423. 

1. Ref. (a) is canceled herewith. 

2. Initial chest examination - Roentgenographic examination of the chest shall 
be made as a part of the physical examination to determine physical fitness 
for original entry into the service and for active duty, also of candidates for 
entrance to the Naval Academy and of candidates for officer training, either as 
a part of the examination to determine their fitness for training or upon report- 
ing to the school. Recruits who have received roentgenographic examination 

of the chest during enlistment or induction with negative findings do not require 
another upon arrival at a naval training station or Marine recruit depot. 

3. Periodic examinations - Roentgenographic examination of the chest of all 
naval and Marine Corps personnel on active duty who have not been so ex- 
amined during the previous 12 months shall be made at the earliest opportunity. 

- 38 - 

Burned News Letter, Vol. 5, No. 5 


Thereafter, chest examinations of personnel on active duty under the age of 30 
shall, if practicable, be made at least once annually. Personnel of any age 
who have X-ray findings of possible future significance shall receive this ex- 
amination every 6 months, where possible, using 14x1 7-inch film. 

4. Final chest examination - Roentgenograph^ examination of the chest of 
all naval and Marine Corps personnel shall be made and the interpretation 
entered in the health record during the physical examination at the time of 
release from active duty or discharge from the service unless such an exami- 
nation has been made and the interpretation recorded in the health record 
during the previous 6 months. 

5. Equipment - All naval and Marine Corps activities with the necessary X- 
ray equipment shall be considered as available for these examinations, and 
whenever practicable the examinations shall be made by the photofluorographic 
technique for conservation of film. Stationary photofluorographic units are 
located in the navy yards and at other shore stations where the need for such 
examinations is sufficiently great. The equipment and personnel of each 
photofluorographic unit will be adequate to examine 125 to 150 persons an hour. 

6. Reexamination - Individuals in whom the photofluorographic film discloses 
abnormal conditions shall be reexamined by means of a 14x1 7-inch film prior 
to final action in their cases. Transfer to a naval hospital solely for this re- 
examination is not necessary if means for obtaining it is otherwise available. 
When individuals are not available for reexamination, their commanding offi- 
cers shall be notified by letter and a copy of this letter forwarded to the 
Bureau of Medicine and Surgery, preferably with the films and reports. The 
reexaminations shall be made at the first opportunity and individual reports 
forwarded to the Bureau of Medicine and Surgery in accordance with paragraph 
12(a) (3). 

7. Causes for rejection - Causes for rejection for original entry into the serv- 
ice shall be as follows: 

(a) Any evidence of reinfection (adult) type tuberculosis, active or inactive, 
other than slight thickening of the apical pleura or thin solitary fibroid strands. 

(b) Evidence of active primary (childhood) type tuberculosis. 

(c) Extensive multiple calcification in the lung parenchyma, or massive 
calcification in the hilus, or any calcification of questionable stability. 

Cd) Evidence of fibrous or serofibrinous pleuritis, except moderate dia- 
phragmatic adhesions with or without blunting or obliteration of the costo- 
phrenic sinus. 

(e) Other disqualifying defects demonstrable by a roentgen examination 
of the chest. (See paragraph 1477, Manual of the Medical Department.) 

- 39 - 

Burned News Letter, Vol. 5, No. 5 


NOTE: When recording interpretations, the word "negative" should be 
used only when the lung fields are without abnormality; defects considered 
not disqualifying should be fully described and noted as not considered dis- 

8. Disposition of recruits - All recruits found to have tuberculosis or other 
disqualifying defect during the physical examination made at a training sta- 
tion (or other station) to determine fitness for active duty shall be invalided 
from the service. The condition will be considered as existing prior to en- 
listment and not in the line of duty. These cases will be discharged after ap- 
proval of the recommendation of a board of medical survey by the proper 
authority, without prior approval by the Bureau of Medicine and Surgery and 
the Bureau of Naval Personnel, or in the case of the Marines, the Commandant, 
U. S. Marine Corps. Report of medical survey stating the action taken and 
date shall be forwarded in quadruplicate to the Bureau of Medicine and Surgery. 

9. Disposition of personnel at periodic examination - Causes for further clini- 
cal study, treatment and disposition of personnel in the service other than 
recruits shall be those stated in paragraph 7. The extent of the clinical study 
required shall be determined in the individual instance by the medical officer 
who has cognizance of the case. Each case shall be disposed of on its own 
merits and with a view to the effects of hardships incident to active service on 
the lesions under consideration. 

10. Disposition of personnel at time of release from active duty or separation 
from the service - Individuals with X-ray evidence of chest pathology in which 
there is reason to believe that active disease may be present shall be hospi- 
talized for further study with a view to definite establishment of their physi- 
cal status prior to release from active duty or discharge. 

11. Recording results - The results of roentgenographic examinations of the 
chest shall be recorded and forwarded as follows: 

(a) Laboratory log - An accurate log of photofluorographic examinations 
of the chest shall be kept by the station at which the examinations are made. 
This record shall contain the name in full, service number, date and place of 
birth, date the examination was made, the number of the film, the interpreta- 
tion and the name of the roentgenologist. This log shall be initialed daily by 
the medical officer in charge of the unit who shall be responsible for the 
accuracy of the entries. The data on log can be used to record examinations 
on NavMed Form H-8 (Medical History Sheet) of the Health Record. 

In the case of mobile photofluorographic units, the log for each station 
shall be left with the station where the examinations were made. 

In the case of stationary photofluorographic units, the log used for the 

- 40 - 

Burned News Letter, Vol. 5, No. 5 


examination of the personnel of another ship or station shall be retained where 
the examinations were made. 

(b) Identification of film - Upon each film must appear the following data: 

(1) Station symbol of the station on which the examination is made, as 
listed in the Navy Filing Manual. 

(2) The film number. 

(3) The date. 

(1) (2) (3) 
Example "NYl-99,999 3-5-45." 

In addition to the above, mobile photofluorographic units shall enter the 

symbol of the unit. 

In order that films filed in rolls may be quickly found upon request, it 
is essential that all photofluorographic film be numbered in consecutive numer- 
ical order. This will necessitate a change in the numbering system used in a 
small minority of the stations. Numbering should progress from 1 to 99,999, 
and then repeat. 

When 14x1 7-inch films are made, the same data shall be entered, and 
whenever possible, the same film number should be used which appears on the 
corresponding photofluorogram. 

(c) Health record - The place, date, film number and report of the inter- 
pretation shall be entered on NavMed Form 8 (Medical History Sheet) of the 
Health Record. The station and film number mentioned above must be entered 
without fail, for without this information the film cannot be located in the files, 

12. Films shall be forwarded to the Bureau of Medicine and Surgery as follows; 

(a) At naval activities other than naval recruiting stations and armed 
forces induction centers. 

(1) All 35 mm. photofluorographic film shall be joined together in a 
continuous roll for each period of time covered. In this connection, splicing done with a view to permitting ready passage of the finished roll 
through the viewer. Splicing is easily done by scraping the emulsion from a 
narrow strip at the ends of the strips of film and using acetone as the adhesive. 
Films which show positive findings, or which are considered to be technically 
unsatisfactory, shall be left in the roll. Technically unsatisfactory films shall 
be defaced by crossed lines made with a colored wax pencil or other means. 
The roll shall be forwarded to the Bureau for review, together with individual 
reports of all 14x1 7-inch X-ray examinations made for persons whose phofo- 
fluorograms are in the roll. In addition there shall be submitted a Report of 
Photofluorographic Chest Survey as prescribed by paragraph 13 below. 

- 41 - 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

The roll of films, the reports of 14x1 7-inch films, and the Report of 
Photofluorographic Chest Survey shall be forwarded to the Bureau of Medicine 
and Surgery in one package addressed "Attention of Tuberculosis Control 
Section." Shipment may be made weekly or semi-monthly. When films made 
for the personnel of more than one activity are joined in the same roll, sepa- 
rate Reports of Photofluorographic Chest Survey should be forwarded for each 
activity concerned. 

(2) 4x5 -inch photoroentgenograms, identified in accordance with para- 
graph 1Kb), shall be forwarded to the Bureau for review. They need not be 
joined into a roll, but shall be placed in consecutive numerical order. They 
should be forwarded at the intervals, and accompanied by the required reports, 
listed above. Upon completion of the review the films will be returned to the 
station -for filing. They shall be filed for a minimum period of 4 years, avail- 
able upon request. 

(3) 14x1 7-inch roentgenographic films, identified in accordance with 
paragraph 1Kb), shall not be forwarded to the Bureau but shall be filed at the 
station where the examinations were made for a period of not less than 4 years. 
An individual report for each person so examined shall be forwarded for file 
and shall contain the date and place of examination, the name of the examinee 
in full, the service number, the date and place of birth, the interpretation, the 
signature of the roentgenologist, disposition of the case, and the station symbol 
and number of the corresponding photofluorogram when one has been made. 

(b) Examinations made under contract - When roentgenological examina- 
tions of the chest are made under contract, such film shall be interpreted by 
a naval medical officer and the disposition of films and reports shall be in 
accordance with the foregoing. In this connection such film should be not 
forwarded to the Bureau of Medicine and Surgery until the interpretations have 
been recorded and the reports prepared. 

(c) At naval recruiting stations and armed forces induction centers - 
Roentgenographic films of the chest of individuals examined at naval recruit- 
ing stations and armed forces induction centers shall be securely stapled to 
the copy of NavMed Form H-2 (Physical Examination) and forwarded to the 
Bureau of Medicine and Surgery for file. 


13. Report of Photofluorographic Chest Survey (NavMed 618) - This report 
shall be forwarded to the Bureau of Medicine and Surgery with each roll or 
package of film described in paragraph 12(a) and (b) above. The following 
form shall be used and prepared locally until such time as it is listed in the 
Naval Medical Supply Catalog: 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 



Photofluorogram # "to 


Station complement 

Number requiring photofluorogram • 

Number examined by photofluorogram _ 

Number reexamined because of technically uns at. film. ., 

Number reexamined by 14x17 roentgenogram _ 

Number disqualified or referred for further clinical study 


Other (itemize) 

(NOTE): Include section B when the survey includes the enrollment of a 


School enrollment 

Number requiring photofluorogram 

Number examined by photofluorogram 

Number reexamined because of technically unsat. film 

Number reexamined by 14x17 roentgenogram 

Number disqualified or referred for further clinical study 


Other (itemize) 

(MC) , USN 

147~Requests for films - When a request is made of the Bureau to forward a 
photofluorogram, such request shall include the name in full, file or serial 
number, date and place of birth, station at which the, examination was made, 
film number, and date of the examination. -BuMed. Ross T. Mclntire. 

Burned News Letter, Vol. 5, No. 5 


To: All Ships and Stations. BUMED- MH6-SE H:mf 


Subj: Recommendations and Orders for Enlisted 

Personnel to Training Courses Listed in 20 Jan 1945 

Catalog of Hospital Corps Schools and 
Courses, Revised 1944 - Policy with Respect to. 

Refs: (a) App. D, Manual of the Medical Department, Bureau Circ. Ltr M. 
. (b) BuMed Form Ltr No. 13, of 7 Nov 1941. 

(0 BuMed Ltr H-RLS/P11-1/MMQ11) , of 20 Jun 1942. 

Cd) Catalog of Hospital Corps Schools and Courses, Revised 1944. 

1. Reference (b) and reference (c) and paragraph (6) of reference (a) are hereby 
canceled. That part of paragraph (7) of reference (a), insofar as Hospital Corps - 
men are concerned, is also canceled. 

2. Effective 15 February 1945, responsible medical officers shall submit to 
their respective commandant or administrative command on the fifteenth of 
each month, recommendations for Hospital Corps enlisted personnel for special 
instruction, combining all recommendations in one letter. The names of person- 
nel recommended shall be listed alphabetically by rating with the title of the 
course for which recommended opposite each name. 

3. In general, Hospital Corps enlisted personnel will not be recommended or 
ordered for Navy training in more than one technical specialty, except that den- 
tal technologists (general) may be also recommended or ordered to training in 
dental technology (prosthetic) . Any technician may be recommended or ordered 
to training in medical field service. 

4. It is directed that upon successful completion of a course in dental technol- 
ogy (prosthetic), the qualification "dental technologist (general)" be deleted 
from the records of Hospital Corps enlisted personnel concerned, and that they 
be listed on all subsequent required reports as dental technologists (prosthetic) only. 

5. It is not the policy of this Bureau to nominate Hospital Corps enlisted per- 
sonnel to BuPers from activities and units serving under the jurisdiction of 
the fleets for transfer to activities in the continental limits of the United States 
for courses of instruction in Medical Department technical specialties, except 
in outstanding cases or in the instances of experienced personnel for training 
in the submarine service, medical field service and deep-sea diving. 

6. All Hospital Corps enlisted personnel will be placed under instruction in 
technical specialties on BuPers orders to commandants and administrative 
commands. Medical Department activities will receive orders from comman- 
dants and administrative commands with respect to personnel for instruction, 
on convening dates specified. --BuMed. Ross T. Mclntire. 


- 44 - 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

To- All Ships and Stations. BUMED-MH3-DCB 


Subj: Prerequisites to Training Courses Listed in 

Catalog of Hospital Corps Schools and Courses, 20 Jan 1945 
Revised 1944, To Form Basis for Recommen- 
dations of or Orders to Enlisted Personnel. 

Ref: (a) Catalog of Hospital Corps Schools and Courses, Revised 1944. 

Encl: (A) Addendum to Catalog of Hospital Corps Schools and Courses, 
Revised 1944. 

1 Effective 14 February 1945, provisions of enclosure (A) shall form the basis 
for recommending or ordering Hospital Corps enlisted personnel to courses of 
instruction listed in reference (a) . 

2 Every effort shall be made to locate personnel meeting ' 'Desirable Qualifi- 
cations" in whole or in part, and personnel shall not be recommended or 
ordered to instruction who do not meet the "Minimum Qualifications" of enclo- 
sure (A) . 

3 District medical officers shall promptly advise the Bureau in instances 
where quotas for instruction cannot be filled with personnel meeting at least 
"Minimum Qualifications." 

4. It is directed this letter and enclosure (A) be made a part of reference (a) 
and referenced in all pertinent communications dealing with training of Hos- 
pital Corps Personnel. -BuMed. Ross T. Mclntire. 



Revised 1944 


Revised 1944 

(Motivation and aptitude will be considered in all cases.) 
Minimum Qualifications parable qualifications 

(Equivalent qualifications will be (In addition to "Minimum Qualif lea- 

acceptable) tions," "Desirable Qualifications 

have been established on an aver 
age level. Higher qualifications 
are desirable in every instance.) 


(a) Selection at recruit training stations. 

(b) Direct enlistment as HA2c, USNR- 

Burned News Letter, Vol. 5, No. 5 

(c) Change of rate - 

2 years high school. High-school graduate. 

Recommendation of MO. Special training in related fields 

BuMed approval when indicated in Cor striker) . 

accordance with current instructions. 


Men only. Typing. 
2 years high school. High-school graduate. 

High- school graduate. Business school or business ex- 

Typing. perience. 

High- school graduate. 


Office experience. 

High- school graduate (including course Laboratory experience. 

in chemistry or physics or biology). Pre-med courses. 

2 years high school and significant College graduate. 

laboratory experience. Pharmacists (graduate) . ■ 

2 years high school High- school graduate. 

Business experience. 


Men onl y- High- school graduate. 

Physically qualified. 

2 years high school. 


2 years high school. High-school graduate. 

Recommended by dental officer. Dental experience. 

2 years high school. High- school graduate. 

Manual dexterity. Dental (prosthetic) experience. 

Mechanical ability. Den ta 1 technologist (general) . 

Recommended by dental officer. 

- 46 - 

Burned News Letter, Vol. 5, No. 5 RESTRICTED 

High- school graduate. Nursing experience. 

2 years high school. High-school graduate. 

Print-shop experience. Printer or related trade. 

(Ref. (a) P IV) 

2 years high school. High-school graduate. 

Mechanical and electrical ability. 

High-school graduate (including course Mechanical and electrical ability . 

in physics) . 

High- school graduate. Pre-med courses. 

College graduate. 
High- school biology, mathematics, 
and chemistry. 

2 years high school. High- school graduate. 

Nursing experience. 

2 years high school. High-school graduate. 

Mechanical ability. 

High-school graduate. High-school course in biology. 

Hospital apprentice 2c. First-aid training or experience. 

High-school graduate or 2 years high- Related experience (commercial 

school and related experience. or amateur) . 

2 years high school. High- school graduate. 

Nursing experience. 

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Burned News Letter, Vol. 5, No. 5 RESTRICTED 

: (Ref. (a) P 26) 

2 years high school. High- school graduate. 

Typing. Office experience. 


High- school graduate. College training. 

2 manual skills (e.g., weaving, pottery, Teacher training. 

printing, etc.) Related work (e.g., atypical chil- 

dren, blind, deaf, etc.) • 

2 years high school. Hospital experience. 

PhM2/c - men only. PhMl/c. 
2 years high school. High-school graduate. 

Age 22 to 35 years. First-aid experience. 

Emotionally stable. College training. 

Discontinued until further notice. 

2 years high school. High-school graduate. 

Related experience. 
High-school graduate. Business-high-school graduate. 

2? mS - . College training. 

Office experience. , Bookkeeping or/and accounting 


High-school graduate. PhMl/c 

VoJ^teeJ qUaUfied ' " ° nl7 - Graduate of Hos P ital Corps School 

-m^/i-OAw' j * T^i* n jrt (intermediate course) . 

F^niJT f tt PhMVC) • First-aid experience. 

Emotionally stable. Experience on duty independent 

Age 22 to 30 preferred. Well -qualified 0 f a medical officer 

men up to 36 years of age may be selected. 
Minimum requirements as published in cur- 
rent BuPers instructions. 

High-school graduate. College training. 

Mechanically inclined. High-school or college courses 

in physics. 

Photography experience (commer- 
cial or as hobby) . 
Mechanical ability.